St. Dominic Medical Associates LLC
NPI 1407920549 · Family Medicine Physician · Jackson, MS
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
St. Dominic Medical Associates LLC is a Family Medicine Physician organization in Jackson, MS (NPI 1407920549).
Provider details
- NPI number
- 1407920549
- Entity type
- Organization
- Primary specialty
- Family Medicine PhysicianAllopathic & Osteopathic Physicians
- Parent organization
- St Dominc Jackson Memorial Hospital
- Organization subpart
- Yes
- Authorized official
- Danielle Stuart, Credentialing Specialist(601) 200-4880
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Surgical Critical Care Physician2086S0102X
Allopathic & Osteopathic Physicians
- Urology Physician208800000X
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
- Pain Medicine Physician208VP0000X
Allopathic & Osteopathic Physicians
- Neurological Surgery Physician207T00000X
Allopathic & Osteopathic Physicians
- Gynecologic Oncology Physician207VX0201X
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2006-11-20
- Last updated
- 2021-11-18
- Certified
- 2021-11-18
Frequently asked questions
- What is St. Dominic Medical Associates LLC's NPI number?
- St. Dominic Medical Associates LLC's National Provider Identifier (NPI) is 1407920549, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is St. Dominic Medical Associates LLC?
- St. Dominic Medical Associates LLC is classified in the NPPES registry as Family Medicine Physician (Allopathic & Osteopathic Physicians).
- Where is St. Dominic Medical Associates LLC located?
- St. Dominic Medical Associates LLC's practice location on file with NPPES is 969 Lakeland Dr, Jackson, MS 39216-4606.
- What is St. Dominic Medical Associates LLC's phone number?
- The practice phone number listed in the NPPES registry for St. Dominic Medical Associates LLC is (601) 200-4749.
- Does St. Dominic Medical Associates LLC accept Medicare?
- St. Dominic Medical Associates LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for St. Dominic Medical Associates LLC?
- The authorized official listed on St. Dominic Medical Associates LLC's NPPES record is Danielle Stuart, Credentialing Specialist. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is St. Dominic Medical Associates LLC's NPI active?
- Yes — St. Dominic Medical Associates LLC's NPI (1407920549) is active in the NPPES registry as of the last update on 2021-11-18.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.